Recent Comments

I am happy that you read the article and expressed concerns about the article written by Dr. Malek and myself. We take issue with your characterization of urinary tract infections in some if not many residents in long term care. Many are not able to express their symptoms so the fact that they don't complain is a common confounding factor in diagnosis. The lack of fever is well known to be a feature of infections in elderly, especially the very old. The lack of blood urine does not mean that there is no infection. No one of the authors suggests that other causes of acute delirium should not be explored- that is the usual differential when evaluating such patients. The two authors have had extensive experience in long term care and have seen many patients with subclinical symptoms point to UTI but had acute delirium for which no other cause could be found. Sometimes rather than a higher white blood only a shift to the left is seen on the differential which is not always done with automated measurements. Often a few doses of antibiotic treatment results in the return to previous cognitive status, long before the full course of antibiotics is completed. The reference we used confirmed our statements, so this is not a red-herring as you imply that it interferes with finding other causes of delirium such as medications or metabolic disorders.